Exercise advice

Exercise in arthritis.

Different types of exercise are available.

Isometric - Exercise against resistant with sustained muscle length. The exercising limb therefore doesn't move.
Isotonic - Exercise with constant resistance or force. Here the limb is moving -  a dynamic form of exercise.
Isokinetic - Exercise with a constant velocity of movement - also a dynamic form of movement.

Sustained muscle exercise programs lead to an increase in muscular fitness, but by maintaining heart and lung aerobic activity over time, the patient also develops an increase in cardiovascular fitness. This enables the patient to sustain muscular activity more efficiently.

In the rheumatic diseases there is a tendency for the patient to develop degrees of muscular imbalance and wasting and thinning of muscle bulk. This can develop rapidly within weeks on either side of affected joints. This plus pain promotes increasing weakness in the muscles, and if the patient is inactive or even worse, bedridden, then the disuse of the muscles increases the loss of muscle bulk and strength even more rapidly. The consequence of inactivity is also aggravated by contracture of joints which leads to inefficiency of muscle contraction and results in loss of function.

The Rheumatic diseases therefore pose major challenge to the patient, family, and therapists. Physical therapists, biokinetics specialists, and exercise specialists therefore have much to offer in rehabilitation and disease prevention.

Such patients have problems which make the performance of exercise more difficult. Pain is the major limitation, and requires therefore disease control as well as pain control. Joint range of movement must be maintained, and in severe active inflammation, joints should be passively moved through their ranges of movement. This phase of disease also may be assisted by splinting where appropriate. Physiotherapists, physical therapists, and occupational therapists are particularly adept at doing this. However as pain is controlled, active exercise must be introduced, with movement against some resistance. Thereafter a program of progressive exercise against resistance is implemented to gain progressive muscle strength. Thereafter mobilisation should include some form of cardiovascular fitness training including a form of endurance exercise.

Choice of exercise should be catered individually for the patient and to be prescriptive may be counterproductive, as an unpopular exercise program leads to an unhappy patient who soon gives up the effort. However the physician needs to be realistic. Severe lower limb arthritis, may make it difficult or unwise to encourage impact, and therefore a low impact exercise such as swimming and possibly a stretch aerobic exercise might be first choice. A moderate walking program with a good soft leather upper, and soft rubbery sole footwear, as provided by most sports shoes, is also a good idea, especially if exercise is done on a flat surface. A further advantage to weight bearing exercise is weight reduction where required and prevention of osteoporosis.

If there is a aggravation of the pain after exercise, and this is not eased rapidly after the exercise stops, then it is suggestive that the exercise be adjusted, either in aggression or in duration or type of exercise itself.

Dr David Gotlieb
drdoc on-line
Cape Town
 

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